MEDICARE: DR. LUCIETTE SAAD-BOTROS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A75553	CA

General Provider Information

NPI Number	:	1336135797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUCIETTE SAAD-BOTROS M.D.

Provider Business Mailing Address
First Line	:	6041 CADILLAC AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1702
Country	:	US
Telephone Number	:	323-857-2120
Fax Number	:	323-857-3946

Provider Business Practice Location Address
First Line	:	6041 CADILLAC AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1702
Country	:	US
Telephone Number	:	323-857-2120
Fax Number	:	323-857-3946

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	12/01/2021

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